Dengue death not an ‘accident’, says consumer panel, junks nominee plea

Ghaziabad: Death caused by dengue does not qualify as an "accident", the district consumer disputes redressal commission has ruled, rejecting a claim for accidental death benefits under a life insurance policy.The commission observed that dengue, a mosquito-borne disease, is neither unexpected nor unforeseen, and therefore falls outside the scope of the policy's "accidental benefit" clause. However, the panel directed the Life Insurance Corporation of India (LIC) to pay the policyholder's nominee the basic sum assured of Rs 10 lakh. The insurer was also asked to add interest at 6% per annum, calculated from the date of the policyholder's death.
Commission president Anil Kumar Pundir and members Shailja Sachan and RP Singh, on Feb 23, ruled that LIC should also pay an additional Rs 10,000 towards the physical and mental agony caused to the nominee, Vaibhav Teotia. The Modinagar resident had filed an application seeking directions to LIC for refusing to honour the insurance claim and accidental benefit towards a policy purchased by his mother, Navita Nehra. Teotia told the commission that his mother had taken a life insurance policy with a sum assured of Rs 10 lakh in Nov 2013. He said the policy was issued after all due procedures were completed, including a medical examination, and also included accidental death benefits. Two years later, in Nov 2015, his mother contracted dengue and later died of dengue shock syndrome. The family subsequently submitted a claim to the insurer. LIC, however, rejected the claim in Sept 2016, citing non-disclosure of earlier insurance policies in the proposal form. The complainant, Teotia, argued that the omission did not amount to concealment of facts and alleged that LIC's refusal to pay constituted unfair trade practice and a deficiency in service.LIC, in its written reply, countered that the policyholder had given incomplete and incorrect information, failing to disclose four earlier policies. The insurer said this information was crucial to assessing the risk and would have required a special medical report. Such non-disclosure, LIC argued, amounted to fraud. The counsel also reiterated that death due to dengue could not be treated as accidental, maintaining that the claim was rightly rejected and that there was no lapse in service.After hearing both sides, the commission held that, as laid down by the National Consumer Disputes Redressal Commission, the burden was on the insurer to prove that non-disclosure of earlier policies was material and would have led to rejection of the proposal or a higher premium.It noted that Life Insurance Corporation of India failed to cite any circular or rule to show that disclosure of previous policies would have resulted in rejection of the proposal or additional premium. The insurer also did not produce evidence to establish that the policyholder had deliberately concealed details of earlier policies. On this basis, the commission directed LIC to pay the sum assured of Rs 10 lakh.However, citing Supreme Court's ruling in 2019 case of branch manager, National Insurance Company Limited vs Smt Moushumi Bhattacharjee and others, the commission noted that "encephalitis malaria caused by a mosquito bite cannot be considered an accident, as it is neither unexpected nor unforeseen, and is not a peril covered under an accident insurance policy."Applying the same reasoning, the commission said that since the cause of death in the present case was dengue—a mosquito-borne disease—it could not be classified as death due to an accident under the policy.Get the latest lifestyle updates on Times of India, along with Holi wishes, messages and quotes !